..NR548 Exam 2 (Latest Update) Questions
and Answers (100% Guaranteed Pass).
Psychiatric interview the process by which psychiatric
assessment is conducted
-primary tasks
• building a therapeutic alliance between the PMHNP & client
• obtaining a database of psychiatric info about the client
• establishing a dx
• negotiating a tx plan
Therapeutic Alliance
a feeling that you should create over the course of the diagnostic interview, a sense of rapport, trust, and
warmth
-most important goal of the interview process
-the cooperative working relationship between the therapist and client
• begins during the initial or opening phase of the interview
-fundamental component of successful therapy
• Without trust, adherence to treatment recommendations may be compromised
• interview may not elicit the information needed to formulate an appropriate dx & plan of care without
rapport & trust
Creating rapport: tips
-Be Yourself
-Be Warm, Courteous, and Emotionally Sensitive
-Actively Defuse the Strangeness of the Clinical Situation
,-Give Your Patient the Opening Word
-Gain Your Patient's Trust by Projecting Competence
How to approach threatening topics (sensitive/embarrassing material)
-Normalization
-Symptom Expectation
-Symptom Exaggeration
-Reduction of Guilt
-Use Familiar Language When Asking about Behaviors
Normalization
Introducing Q with some type of normalizing statement
-two principal ways to do this:
1. start the question by implying that the behavior is a normal or understandable response to a mood or
situation
• ex: Sometimes when people are very depressed, they think of hurting themselves. Has this been true for
you?
2. Begin by describing another patient (or patients) who has engaged in the behavior, showing your
patient that she is not alone
• ex: I've talked to several patients who've said that their depression causes them to have strange
experiences, like hearing voices or thinking that strangers are laughing at them. Has that been happening
to you?
Symptom Expectation communicate that a behavior is in some
way normal or expected
-Phrase your Q's to imply that you already assume the patient has engaged in some behavior and that you
will not be offended by a positive response
-high index of suspicion of some self-destructive activity
, -Ex: patient is profoundly depressed and has expressed feelings of hopelessness. You suspect suicidality,
but you sense that the patient may be too ashamed to admit it. Rather than gingerly asking "Have you had
any thoughts that you'd be better off dead?" you might decide to use symptom expectation. "What kinds
of ways to hurt yourself have you thought about?"
*reserve this technique for situations in which it seems appropriate
Symptom Exaggeration
suggesting a frequency of a problematic behavior that is higher than your expectation, so that the patient
feels that their actual, lower frequency of the behavior will not be perceived by you as being "bad."
-helpful in clarifying the severity of symptoms
*reserve this technique for situations in which it seems appropriate
Reduction of guilt
seeks to directly reduce a patient's guilt about a specific behavior in order to discover what they have been
doing
-useful in obtaining a hx of domestic violence & other antisocial behavior
Domestic Violence
-"Have you ever been in situations where fights occurred and you were affected?"
• If patient answers "yes," you can flesh out whether role was being a witness, victim, or perpetrator
According to Peplau's Theory of Interpersonal Relations, establishing early rapport allows the role of the
nurse to evolve from stranger to:
resource person, teacher, leader, surrogate, technical expert, and counselor
Establishing the Relationship
and Answers (100% Guaranteed Pass).
Psychiatric interview the process by which psychiatric
assessment is conducted
-primary tasks
• building a therapeutic alliance between the PMHNP & client
• obtaining a database of psychiatric info about the client
• establishing a dx
• negotiating a tx plan
Therapeutic Alliance
a feeling that you should create over the course of the diagnostic interview, a sense of rapport, trust, and
warmth
-most important goal of the interview process
-the cooperative working relationship between the therapist and client
• begins during the initial or opening phase of the interview
-fundamental component of successful therapy
• Without trust, adherence to treatment recommendations may be compromised
• interview may not elicit the information needed to formulate an appropriate dx & plan of care without
rapport & trust
Creating rapport: tips
-Be Yourself
-Be Warm, Courteous, and Emotionally Sensitive
-Actively Defuse the Strangeness of the Clinical Situation
,-Give Your Patient the Opening Word
-Gain Your Patient's Trust by Projecting Competence
How to approach threatening topics (sensitive/embarrassing material)
-Normalization
-Symptom Expectation
-Symptom Exaggeration
-Reduction of Guilt
-Use Familiar Language When Asking about Behaviors
Normalization
Introducing Q with some type of normalizing statement
-two principal ways to do this:
1. start the question by implying that the behavior is a normal or understandable response to a mood or
situation
• ex: Sometimes when people are very depressed, they think of hurting themselves. Has this been true for
you?
2. Begin by describing another patient (or patients) who has engaged in the behavior, showing your
patient that she is not alone
• ex: I've talked to several patients who've said that their depression causes them to have strange
experiences, like hearing voices or thinking that strangers are laughing at them. Has that been happening
to you?
Symptom Expectation communicate that a behavior is in some
way normal or expected
-Phrase your Q's to imply that you already assume the patient has engaged in some behavior and that you
will not be offended by a positive response
-high index of suspicion of some self-destructive activity
, -Ex: patient is profoundly depressed and has expressed feelings of hopelessness. You suspect suicidality,
but you sense that the patient may be too ashamed to admit it. Rather than gingerly asking "Have you had
any thoughts that you'd be better off dead?" you might decide to use symptom expectation. "What kinds
of ways to hurt yourself have you thought about?"
*reserve this technique for situations in which it seems appropriate
Symptom Exaggeration
suggesting a frequency of a problematic behavior that is higher than your expectation, so that the patient
feels that their actual, lower frequency of the behavior will not be perceived by you as being "bad."
-helpful in clarifying the severity of symptoms
*reserve this technique for situations in which it seems appropriate
Reduction of guilt
seeks to directly reduce a patient's guilt about a specific behavior in order to discover what they have been
doing
-useful in obtaining a hx of domestic violence & other antisocial behavior
Domestic Violence
-"Have you ever been in situations where fights occurred and you were affected?"
• If patient answers "yes," you can flesh out whether role was being a witness, victim, or perpetrator
According to Peplau's Theory of Interpersonal Relations, establishing early rapport allows the role of the
nurse to evolve from stranger to:
resource person, teacher, leader, surrogate, technical expert, and counselor
Establishing the Relationship
